Dr Bohee Lee receives NIHR Postdoctoral Award to support research into preschool wheeze

Dr Bohee Lee, Research Associate at the National Heart and Lung Institute (NHLI), is set to embark on a National Institute for Health and Care Research (NIHR) Postdoctoral Fellowship (Cohort 2).

The award, which will support Dr Lee’s research from 2027-2031, is designed to support future research leaders to take the next step in their career.

It will facilitate Dr Lee’s PRELUDE study (PREventative strategies for improving LUng health in chilDrEn: from womb to early childhood), which will aim to uncover potential primary intervention strategies to tackle preschool wheeze.

Understanding preschool wheeze

Preschool wheeze is wheezing in children under 5 who have not been diagnosed with asthma. It is very common, with 1 in 3 children experiencing an episode of wheezing before their third birthday. Many grow out of the condition by the time they are 5 or 6 years old, but around 30% go on to develop asthma, which can cause severe damage to the lungs.

Dr Lee’s research is centred on identifying preventative strategies for preschool wheeze. “The majority of current intervention strategies for preschool wheeze are secondary”, Dr Lee explained. “When a child has a wheezing episode, the focus is on stopping it from happening again.”

“Instead, I am hoping to prevent the wheezing episode from happening at all by investigating potential triggers that occur when the lungs and immune system are still developing, in utero.”

Tackling the unique challenges of pregnancy research

Looking at the health of the birth parents of children with preschool wheeze may provide clues to risk factors, such as medications and environmental factors that they were exposed to while pregnant. However, including pregnant people as participants in a clinical trial is difficult, as this can raise significant ethical concerns.

Dr Lee’s research will seek to overcome this barrier by choosing instead to analyse NHS records and clinical data relating to the pregnancies of parents with children who have developed pre-school wheeze, to try to establish causal associations between potential risk factors and the development of the condition.

To this end, the PRELUDE study will utilise information from the Clinical Practice Research Datalink (CPRD), the UK’s largest health data resource, which is linked to pregnancy registry data. “This is key in an epidemiological study like PRELUDE,” said Dr Lee, “because a very large sample size can bolster the statistical power of potential links.”

Applying a state-of-the art analytical method such as target trial emulation to the existing real-world data is crucial in opening the door to a future clinical trial, as it is only through such an approach that real-life conclusions concerning risk factors for pre-school wheeze can be elucidated.

Working together towards a healthier future

Before coming to NHLI, Dr Lee worked as a clinical pharmacist, observing preschool wheeze in many children, and witnessing how much medication they had to take. She then went to University of Edinburgh as a doctoral student, supervised by Professor Steve Cunningham, researching acute episodes of preschool wheeze and the efficacy of oral steroids.

After her PhD, Dr Lee joined the team at NHLI, working with Dr Chloe Bloom, Clinical Associate Professor in Respiratory Epidemiology. Here, she conducted multiple epidemiological studies using CPRD on respiratory diseases.

Speaking about this early period at NHLI, Dr Lee said, "I learnt a great deal from Dr Bloom, particularly concerning epidemiological research skills. Working with her taught me how to leverage healthcare data, from sources like the CPRD, to its full potential.”

The fellowship will generate many new opportunities for Dr Lee, from establishing a resilient project team to working closely with lung health advocacy organisations, like Asthma + Lung UK, and their respective patient involvement groups, and external academic institutes such as University of Edinburgh and Seoul National University (South Korea).

NHLI’s Professor Sejal Saglani and Dr Chloe Bloom will provide their mentorship throughout the fellowship. “By the end of the fellowship, as a respiratory epidemiologist, I would like to provide methodologically robust and clinically meaningful evidence that can improve the current clinical practice”, Dr Lee said.

“Personally, I also want to be a role model for pharmacists who would like to go into clinical research”, she added, noting the growing movement in favour of pharmacists’ inclusion in respiratory research.

“This fellowship offers me the chance to apply state-of-the art epidemiological methods and listen to parents’ concerns to figure out how to prevent preschool wheeze and its longer-term impact on lung health”, Dr Lee remarked.

“I am grateful for the support of NIHR and am looking forward to working on what I hope will be impactful research for children and parents alike.”